Clinicians who want to place a nasal-jejunal feeding tube in their patients currently rely on gravity and peristalsis to carry a blindly passed feeding tube from the stomach into the jejunum, fluoroscopy to pass the feeding tube under radiologic guidance, or per-oral sedated endoscopy to guide a blindly passed transnasal tube from the stomach into the jejunum.
Each of the above-noted procedures is undesirable for one reason or another. For example, the blind placement of a feeding tube into a patient can result in the inadvertent intubation of the trachea and possible bronchopleural injuries. Fluoroscopic placement methods are complicated and require the assistance of a radiology department. Sedation is not desirable and poses an inherent risk.
Another approach is described in Damore et al., “Prospective evaluation of a new through-the-scope nasoduodenal enteral feeding tube”, Surgical Endoscopy, 1997 May; 11(5); 460. This paper describes the use of a bulky per-oral endoscope that requires intravenous sedation. An endoscope is fed through the mouth of a patient and the distal end of the endoscope is placed in the small intestine. A feeding tube that is about twice the length of the endoscope is passed through the endoscope. The feeding tube is then kept in the small intestine and the endoscope is removed over it. This “through the scope” tube placement uses a large caliber per oral esophagoscope. Once the tube is inserted through the mouth and into the intestine, the feeding tube must be transferred from the mouth to the nose. This nasal transfer can be time consuming, difficult, and uncomfortable. In addition, this procedure requires intravenous sedation that poses inherent cost and risk to the patient.
This method also has a number of disadvantages. For example, the procedure is somewhat complex and uses sedation. It would be desirable to provide for a method that is less complex and does not use sedation. Additionally, the endoscope that is used has a large diameter as it needs to accommodate a feeding tube. The endoscope is too large to fit through a nasal cavity of a patient. This is why the complex insertion procedure that is described above is used.
Another method uses a dangling suture at an end of a feeding tube. Forceps in an endoscope are used to “pull” the tube along. This method is also undesirable, as it is difficult to have the forceps grab the single suture. It is also a complicated way to join an endoscope and a feeding tube using multiple mechanisms.
Thus, an improved apparatus and method for inserting a tube such as a feeding tube into a patient is desired. Embodiments of the invention address these and other problems.